Post-operative complications of salvage total laryngectomy forpost-radiotherapy recurrent laryngeal cancer using pectoralis major myocutaneous flaps

Abstract

Background: Salvage surgery for laryngeal cancer recurring after radiotherapy is difficult and complications readily occur. Our institution has adopted the pharyngeal interposition graft (PIG) using a pectoralis major myocutaneous (PMMC) flap, which has copious blood flow, for preventing post-irradiation pharyngocutaneous fistula.

Aims/objectives: The purpose of this study was to examine the incidence of post-operative complications of salvage total laryngectomy (STL) using the PMMC flap for post-radiotherapy recurrent laryngeal cancer at our institution.

Material and methods: From among 162 patients with laryngeal cancer who had been treated at Tokyo Medical University Hospital between January 2014 and March 2018, we enrolled 11 patients who had undergone STL applying a PMMC flap. We examined patient backgrounds (age, gender, subtype, stage), initial therapy (radiotherapy/chemoradiotherapy), radiation dose, irradiation area, surgery type (with/without neck dissection) and postoperative complications.

Results: No severe systemic complications were encountered. Pharyngocutaneous fistula occurred as a severe local complication in one patient (8.3%) and wound infection as a mild local complication in one patient (8.3%).

Conclusions: Rates of post-operative complications following STL tended to be lower at our institution than those reported for other institutions.

Significance: PIG may be a useful surgical procedure in STL.

Chinese abstract

背景：放疗后复发的喉癌救治手术很困难, 并发症很容易发生。我们采用了一种胸大肌肌皮瓣（PMMC）的咽部插入移植（PIG）。该皮瓣具有丰富的血流量, 可用于预防辐照后的咽部皮肤瘘。

目的：本研究的目的是检查使用PMMC皮瓣治疗放疗后复发性喉癌的全喉切除术（STL）术后并发症的发生率。

材料和方法：在2014年1月至2018年3月期间, 在东京医科大学附属医院接受治疗的162例喉癌患者中, 我们招募了11例接受STL并施用PMMC皮瓣的患者。我们检查了患者背景（年龄、性别、亚型、病期）、初始治疗（放射治疗/放化疗）、放射剂量、照射面积、手术类型（有/无颈清扫）和术后并发症。

结果：未发生严重的全身并发症。一名患者（8.3％）发生严重局部并发症的咽部皮肤瘘, 一名患者（8.3％）出现轻度局部并发症。

结论：我们医院STL术后并发症的发生率往往低于其它医疗部门报告的发生率。

意义：PIG可能是STL中有用的外科手术。

Keywords:

• Chemoradiotherapy
• radiotherapy
• salvage total laryngectomy
• pharyngocutaneous fistula

Disclosure statement

No potential conflict of interest was reported by the authors.